Healthcare Provider Details

I. General information

NPI: 1215011143
Provider Name (Legal Business Name): KAREN E BAUMSTARK PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11905 ARBOR ST
OMAHA NE
68144-2970
US

IV. Provider business mailing address

14821 MARTHA CIR
OMAHA NE
68144-2038
US

V. Phone/Fax

Practice location:
  • Phone: 402-330-8850
  • Fax: 402-330-8873
Mailing address:
  • Phone: 402-330-0668
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number287
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: